Systolic ejection click versus split first heart sound: Are our ears deceiving us?
Natalie M Hoeting1, Courtney E McCracken1, Michael McConnell1,2
1Emory University School of Medicine, Atlanta, Georgia, USA.
Congenital Heart Disease
|March 17, 2017
Summary
Pediatric cardiologists struggled to differentiate bicuspid aortic valve (BAV) clicks from benign split first heart sounds, with accuracy below chance. Echocardiograms are recommended for these auscultation findings.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Diagnostic Accuracy
Background:
- Bicuspid aortic valve (BAV) disease carries lifelong risks.
- Auscultation of a BAV click is often missed or misidentified as a benign split first heart sound.
Purpose of the Study:
- To evaluate the ability of pediatric cardiologists to distinguish between BAV clicks and benign split first heart sounds.
- To assess the impact of experience on diagnostic accuracy.
Main Methods:
- A quality evaluation project involving 21 pediatric cardiologists.
- Participants listened to five de-identified pediatric heart sound recordings (three BAV clicks, two split first heart sounds).
- Diagnostic accuracy and interrater reliability (kappa coefficients) were calculated.
Main Results:
- Overall diagnostic accuracy for BAV clicks was 38% and for split first heart sounds was 41%.
- No participant correctly identified all sounds; accuracy was worse than chance.
- No significant difference in agreement was found based on years of experience.
- Interrater agreement (kappa) was poor (0.01), indicating low precision.
Conclusions:
- Pediatric cardiologists demonstrated poor accuracy in differentiating BAV clicks from split first heart sounds.
- Years of experience did not correlate with improved diagnostic ability.
- Echocardiography is suggested for evaluation when either a systolic ejection click or split first heart sound is auscultated.
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